Utilidad de las tiras reactivas para el diagnóstico temprano de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis / Usefulness of test strips for early diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites

Introducción: La peritonitis bacteriana espontánea requiere un diagnóstico temprano para el inicio de antibioticoterapia. El estudio diagnóstico ideal es el citoquímico del líquido ascítico, el cual puede ser costoso, demorado y de disponibilidad limitada en centros primarios de atención en salud. Objetivo: Evaluar la utilidad y precisión diagnóstica de las tiras reactivas Multistix 10SG para el diagnóstico de peritonitis bacteriana espontánea en pacientes cirróticos con ascitis. Materiales y métodos: Estudio observacional descriptivo de prueba diagnóstica en pacientes cirróticos con ascitis. Se determinó el conteo de leucocitos del líquido ascítico por la escala colorimétrica de la tira reactiva Multistix 10SG y se comparó con el gold standard para el diagnóstico (polimorfonucleares ≥ 250 células/mm³). Resultados: De 174 pacientes con ascitis (51,7% mujeres, promedio de edad 59 años) 30 fueron diagnosticados con peritonitis bacteriana espontánea. Con un punto de corte grado ++, la tira reactiva tuvo sensibilidad 73,3%, especificidad 96,5%, valor predictivo positivo 81,4%, valor predictivo negativo 94,5%, razón de probabilidad positiva 21,2 y razón de probabilidad negativa 0,27. Conclusiones: Las tiras reactivas tienen adecuada especificidad y valor predictivo negativo, siendo una herramienta de bajo costo, uso sencillo, rápida interpretación y fácil acceso, para apoyar la decisión de no iniciar antibiótico en pacientes con ascitis y sospecha de peritonitis bacteriana espontánea. Por su baja sensibilidad no reemplazan al estudio citoquímico como prueba de elección para el diagnóstico definitivo, pero si es útil para optimizar el abordaje inicial de estos pacientes.

Introduction: Spontaneous bacterial peritonitis requires an early diagnosis to start antibiotic therapy. The ideal diagnostic study is the cytochemical of ascites fluid, which can be expensive, delayed and of limited availability in primary health care centers. Objective: Evaluate the usefulness and diagnostic accuracy of Multistix 10SG test strips for the diagnosis of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Materials and methods: Observational descriptive study of diagnostic test in cirrhotic patients with ascites. The leukocyte count of ascites fluid was determined by the colorimetric scale of the Multistix 10SG test strip and compared with the gold standard for diagnosis (polymorphonuclear ≥ 250 cells / mm³). Results: Of 174 patients with ascites (51.7% women, average age 59 years) 30 were diagnosed with spontaneous bacterial peritonitis. With a grade ++ cut-off point, the test strip had sensitivity 73.3%, specificity 96.5%, positive predictive value 81.4%, negative predictive value 94.5%, positive likelihood ratio 21.2 and negative likelihood ratio of 0.27. Conclusions: The test strips have adequate specificity and negative predictive value, being a low cost tool, simple use, quick interpretation and easy access, to support the decision not to start an antibiotic in patients with ascites and suspected spontaneous bacterial peritonitis. Due to their low sensitivity they do not replace the cytochemical study as the test of choice for the definitive diagnosis, but it is useful for optimizing the initial approach of these patients.

Inibidores de bomba protônica aumentam o risco geral de desenvolver infecções bacterianas em pacientes com cirrose / Proton pump inhibitors increase the overall risk of developing bacterial infections in patients with cirrhosis

ABSTRACT BACKGROUND: Acid suppression has been associated with adverse events; such as, enteric infections. Proton pump inhibitors (PPI) are frequently prescribed in patients with cirrhosis, but is unclear if PPI are associated with the development of bacterial infections in these patients. OBJECTIVE: To assess the impact of PPI intake on the development of bacterial, viral and fungal infections in patients with cirrhosis. METHODS: An observational, retrospective, historic cohort study. The exposed cohort included patients with cirrhosis with chronic use of PPI. The non-exposed cohort had not been using PPI. The follow-up period was 3 years, searching in the medical records for any events of bacterial infection confirmed by bacteriological culture. RESULTS: One hundred and thirteen patients met the selection criteria, 44 (39%) had chronic use of PPI; of them, 28 (63.6%) patients had not a clear clinical indication to justify the prescription of PPI. Twenty four (21.2%) patients developed bacterial infections during the follow-up period. In the univariate analysis, decompensated cirrhosis (Child B/C), presence of ascites, history of variceal bleeding, and chronic consumption of PPI were risk factors related to the development of infections. But, in the adjusted multivariate analysis only the chronic use of PPI was associated with development of infections (RR=3.6; 95% CI=1.1-12.3; P=0.04). CONCLUSION: There is an over-prescription of PPI without a justified clinical indication. The long-term consumption of PPI in patients with cirrhosis is associated with the development of bacterial infections; therefore these drugs must be carefully prescribed in this specific population.

RESUMO CONTEXTO: A supressão de ácido tem sido associada a efeitos adversos, tais como infecções entéricas. Inibidores da bomba protônica são frequentemente prescritos em pacientes com cirrose, mas não está claro se o inibidor de bomba de próton (IBP) está associado ao desenvolvimento de infecções bacterianas nesses pacientes. OBJETIVO: Avaliar o impacto da ingestão de IBP no desenvolvimento de infecção bacteriana, viral e fúngica em pacientes com cirrose. MÉTODOS: Foi realizado estudo de coorte observacional, retrospectivo, histórico. A coorte exposta incluiu pacientes com cirrose e com uso crônico de IBP. A coorte de não expostos não estava usando IBP. O período de seguimento foi de 3 anos, procurando-se nos registros médicos qualquer evento de infecção bacteriana, confirmada pela cultura bacteriológica. RESULTADOS: Cento e treze pacientes preencheram os critérios de seleção, 44 (39%) pacientes faziam uso crônico de IBP; deles, 28 (63,6%) não tinham uma indicação clínica clara para justificar a prescrição de IBP. Vinte e quatro (21,2%) pacientes desenvolveram infecções bacterianas durante o período de seguimento. Na análise univariada, cirrose descompensada (Child B/C), presença de ascite, história de hemorragia varicosa e consumo crônico de IBP foram fatores de risco relacionados ao desenvolvimento de infecções. Porém, na análise multivariada ajustada, somente o uso crônico de IBP foi associado ao desenvolvimento de infecções (RR=3,6; 95% CI = 1.1-12.3; P=0,04). CONCLUSÃO: Há uma prescrição excessiva de PPI sem uma indicação clínica justificada. O consumo de longo prazo do IBP em pacientes com cirrose é associado ao desenvolvimento de infecções bacterianas. Portanto, essas drogas devem ser cuidadosamente prescritas nesta população específica.

Different Clinical Characteristics Among Aeromonas hydrophila, Aeromonas veronii biovar sobria and Aeromonas caviae Monomicrobial Bacteremia

This study aimed to compare the clinical presentations of Aeromonas hydrophila, A. veronii biovar sobria and A. caviae monomicrobial bacteremia by a retrospective method at three hospitals in Taiwan during an 8-yr period. There were 87 patients with A. hydrophila bacteremia, 45 with A. veronii biovar sobria bacteremia and 22 with A. caviae bacteremia. Compared with A. hydrophila and A. veronii biovar sobria bacteremia, A. caviae bacteremia was more healthcare-associated (45 vs 30 and 16%; P = 0.031). The patients with A. caviae bacteremias were less likely to have liver cirrhosis (27 vs 62 and 64%; P = 0.007) and severe complications such as shock (9 vs 40 and 47%; P = 0.009) and thrombocytopenia (45 vs 67 and 87%; P = 0.002). The APACHE II score was the most important risk factor of Aeromonas bacteremia-associated mortalities. The APACHE II scores of A. caviae bacteremias were lower than A. hydrophila bacteremia and A. veronii biovar sobria bacteremia (7 vs 14 and 16 points; P = 0.002). In conclusion, the clinical presentation of A. caviae bacteremia was much different from A. hydrophila and A. veronii biovar sobria bacteremia. The severity and mortality of A. caviae bacteremia were lower than A. hydrophila or A. veronii biovar sobria bacteremia.

Association between helicobacter pylori seropositivity and hepatic encephalopathy

The knowledge on Helicobacter pylori [H. pylori] contribution in the pathology of the liver and biliary tract diseases in human is very limited. The aim of this study was to assess the probable association between H. pylori seropositivity and hepatic encephalopathy. This is a case control study conducted through three groups, cirrhotics with hepatic encephalopathy [HE], cirrhotics without HE and healthy controls. All subjects were examined serologically for determination of IgG class antibodies to H. pylori based on ELISA technique. H. pylori seropositivity was present in 88% cirrhotic patients with hepatic encephalopathy, 86% cirrhotics without hepatic encephalopathy and 66% healthy controls. According to our results, H. pylori seropositivity rate in cirrhotic patients with or without hepatic encephalopathy was higher than healthy controls. But H. pylori seropositivity rate was not significantly different among cirrhotics with hepatic encephalopathy and those without it

Infecciones en pacientes hospitalizados por cirrosis / Infections in hospitalized patients with cirrhosis

Evaluamos la prevalecencia y relevancia clínica de las infecciones bacterianas y no bacterianas en pacientes cirróticos predominantemente alcohólicos internados en un hospital de mediana complejidad, y comparamos las características clínicas, de laboratorio y la evolución de pacientes con y sin infección bacteriana en un estudio prospectivo de cohorte. Se incluyeron 211 internaciones consecutivas de 132 pacientes con diagnóstico de cirrosis, de abril 2004 a julio 2007. El promedio de edad (±DS) fue 51.8 (±8) años, 112 fueron hombres (84.8%); etiología alcohólica 95.4%. Se diagnosticaron 129 episodios de infecciones bacterianas en 99/211 (46.9%) internaciones, adquiridos en la comunidad 79 (61.2%) y 50 (38.8%) intrahospitalarios: peritonitis bacteriana espontánea (23.3%); infección urinaria (21.7%); neumonías (17.8%); infecciones de piel y partes blandas (17.1%); sepsis por bacteriemia espontánea (7.7%); otras infecciones bacterianas (12.4%). El 52.2% fueron por gérmenes gram-positivos. Hubo ocho casos de tuberculosis e infecciones graves por hongos y parásitos. La prevalecencia de tuberculosis fue del 6% con una mortalidad anual de 62.5%. El 28.1% (9/32) de los exámenes coproparasitológicos tuvieron Strongyloides stercolaris. La mortalidad hospitalaria fue mayor en los pacientes con infección bacteriana (32.4% vs. 13.2%; p=0.02). Fueron identificados como predictores independientes de mortalidad: las infecciones bacterianas, el score de Child-Pügh y creatininemia > 1.5 mg/dl. En el análisis multivariado fueron factores independientes asociados a infección bacteriana la leucocitosis y la encefalopatía hepática grado III/IV. Este estudio confirma que las infecciones bacterianas y no bacterianas son una complicación frecuente y grave en pacientes cirróticos internados, con un aumento de la mortalidad hospitalaria.

We evaluated the prevalence and the clinical relevance of bacterial and nonbacterial infections in predominantly alcoholic cirrhotic patients, admitted to an intermediate complexity hospital, and we also compared the clinical characteristics, laboratory and evolution of these patients with and without bacterial infection in a prospective study of cohort. A total of 211 consecutive admissions in 132 cirrhotic patients, between April 2004 and July 2007, were included. The mean age was 51.8 (±8) years, being 84.8% male. The alcoholic etiology of cirrhosis was present in 95.4%. One hundred and twenty nine episodes of bacterial infections were diagnosed in 99/211 (46.9%) admissions, community- acquired in 79 (61.2%) and hospital-acquired in 50 (38.8%): spontaneous bacterial peritonitis (23.3%); urinary tract infection (21.7%); pneumonia (17.8%); infection of the skin and soft parts (17.1%), sepsis by spontaneous bacteremia (7.7%); other bacterial infections (12.4%). Gram-positive organisms were responsible for 52.2% of total bacterial infections documented cases. There were eight serious cases of tuberculosis, fungal and parasitic infections; the prevalence of tuberculosis was 6% with an annual mortality of 62.5%; 28.1% (9/32) of the coproparasitological examination had Strongyloides stercolaris. The in-hospital mortality was significantly higher in patients with bacterial infection than in non-infected patients (32.4% vs. 13.2%; p=0.02). The independent factors associated with mortality were bacterial infections, the score of Child-Pügh and creatininemia > 1.5 mg/dl. By the multivariate analysis, leukocytosis and hepatic encephalopathy degree III/IV were independent factors associated to bacterial infection. This study confirms that bacterial and nonbacterial infections are a frequent and severe complication in hospitalized cirrhotic patients, with an increase of in-hospital mortality.

Sobrecrecimiento bacteriano intestinal un factor de riesgo de peritonitis bacteriana espontánea y mortalidad en pacientes con cirrosis hepática / Intestinal bacterial overgrowth is a risk factor for spontaneous bacterial peritonitis and mortality in patients with liver cirrhosis

Spontaneous bacterial peritonitis (SBP) is a major and serious complication of liver cirrhosis. Small intestinal bacterial overgrowth (SIBO) has been shown to occur with increased frequency in patients with cirrhosis. Studies have suggested that SIBO may contribute to the development of SBP. Aims: to assess the prevalence of SIBO and its relationship with the mortality in patients with cirrhosis. Patients and Methods: One hundred three cirrhotic patients, 62 male, mean age 56.6 (range 35-89) entered in the study in a four year period with a mean follow-up of 22.2 months (range 3-76). SIBO was evaluated by breath hydrogen test (BHT) with lactulose. A positive BHT was defined as an increase of 20 ppm during the first 60 min after lactulose ingestion. SBP was diagnosed by a polymorphonuclear leukocyte count greater than or equal to of 250 cells/mm3 in ascitic fluid. Results: A 50 percent of cirrhotic patients had SIBO at the beginning of follow-up period. The prevalence of SIBO was similar in patients with Child-Pugh class A, B, or C (48 percent 51 percent and 48 percent patients respectively). The presence of SBP was significantly higher in patients with SIBO (17/54 patients) than patients without SIBO (1/53 patients), p < 0.05. The mortality of cirrhotic patients was higher in the SIBO group than in the non-SIBO group (25/50 versus 16/35 patients. p < 0.05). Conclusions: The results of this study confirm that the presence of SIBO is a risk factor for SBP and mortality in patients with liver cirrhosis. SIBO should be investigated and treated during the follow-up in these patients.

La peritonitis bacteriana espontánea (PBE) es una complicación frecuente y grave en pacientes con cirrosis hepática. El sobrecrecimiento bacteriano intestinal (SBI) ha sido descrito con frecuencia en pacientes con cirrosis. Estudios han sugerido que el SBI puede ser un factor importante en el desarrollo de la PBE. Objetivos: Evaluar la prevalencia de SBI y su relación con la mortalidad en pacientes con cirrosis hepática. Pacientes y métodos: Ciento tres pacientes cirróticos, 67 hombres, edad promedio 58,6 (rango 35-89) entraron al estudio en un período de cuatro años con un seguimiento promedio de 22,2 meses (rango 3-76). El SBI fue evaluado por test de hidrógeno en aire espirado (THE) con lactulosa. Un examen era considerado positivo con un nivel mayor de 20 ppm después de la ingesta de lactulosa en los primeros 60 min. El diagnóstico de PBE se fundamentó en un recuento de polimorfonucleares mayor o igual que 250 células/mm3 en muestra de líquido ascítico. Resultados: El 50 por ciento de los pacientes cirróticos presentó SBI al comienzo de su seguimiento. La prevalencia de SBI fue similar en pacientes cirróticos Child-Pugh A, B, o C (48 por ciento, 50 por ciento y 50 por ciento respectivamente). La presencia de PBE fue significativamente mayor en pacientes con SBI (17/50 pacientes) que en pacientes sin SBI (1/53 pacientes). p < 0,05. La mortalidad de los pacientes cirróticos fue mayor en el grupo con SBI que en el grupo sin SBI (25/50 versus 16/53 pacientes, p < 0,05). Conclusiones: Los resultados de este estudio confirman que la presencia de SBI es un factor de riesgo de PBE y mortalidad en pacientes con cirrosis hepática. El SBI debería ser investigado y tratado durante el seguimiento de estos pacientes.

Peritonite bacteriana espontânea: impacto das mudanças da microbiologia / Spontaneous bacterial peritonitis: impact of microbiological changes

RACIONAL: A peritonite bacteriana espontânea é uma complicação grave nos pacientes cirróticos com ascite, sendo as alterações das características microbiológicas relatadas nos últimos anos de impacto na escolha do tratamento antibiótico. OBJETIVO: Avaliar as mudanças na epidemiologia e na resistência antibiótica de bactérias causadoras de peritonite bacteriana espontânea em um período de 7 anos. MÉTODOS: Foram avaliados retrospectivamente todos os casos de pacientes cirróticos com peritonite bacteriana espontânea cuja cultura do líquido de ascite foi positiva, sendo estudados dois períodos: 1997-1998 e 2002-2003. Foram verificados os microorganismos mais freqüentes e a sensibilidade in vitro aos antibióticos. RESULTADOS: No primeiro período (1997-1998) houve 33 casos, sendo 3 (9 por cento) com infecção polimicrobiana. As bactérias mais freqüentes foram: E. coli em 13 (36,11 por cento), estafilococos coagulase-negativos em 6 (16,66 por cento), K. pneumoniae em 5 (13,88 por cento), S. aureus em 4 (11,11 por cento) e S. faecalis em 3 (8,33 por cento). Em 2002-2003, houve 43 casos, sendo 2 (5 por cento) com infecção polimicrobiana. As bactérias mais freqüentes foram: estafilococos coagulase-negativos em 16 (35,55 por cento) S. aureus em 8 (17,77 por cento), E. coli em 7 (15,55 por cento) e K. pneumoniae em 3 (6,66 por cento). Nenhum paciente realizava profilaxia para peritonite bacteriana espontânea. A prevalência de S. aureus meticilino-resistentes aumentou, no decorrer desse período, de 25 por cento para 75 por cento, tendo a resistência desse patógeno às quinolonas e a sulfametoxazol-trimetoprim evoluído de 25 por cento para 50 por cento; somente a vancomicina demonstrou atividade absoluta no decorrer do referido período. Da mesma forma, a prevalência de E. coli resistente às cefalosporinas de terceira geração e às quinolonas aumentou de 0 por cento para 16 por cento. CONCLUSÃO: Houve modificação da população bacteriana causadora de peritonite...

BACKGROUND: Spontaneous bacterial peritonitis is a serious complication in cirrhotic patients, and the changes in the microbiological characteristics reported in the last years are impacting the choice of antibiotic used in the treatment. AIM: To evaluate the change in the epidemiology and antibiotic resistance of the bacteria causing spontaneous bacterial peritonitis in a 7 years period. METHODS: All the cases of cirrhotic patients with spontaneous bacterial peritonitis with positive cultural examination were retrospectively studied. Two periods were evaluated: 1997-1998 and 2002-2003. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered. RESULTS: In the first period (1997-1998) there were 33 cases, 3 (9 percent) with polymicrobial infection. The most common were: E.coli in 13 (36,11 percent), Staphylococcus coagulase-negative in 6 (16,66 percent), K. pneumoniae in 5 (13,88 percent), S. aureus in 4 (11,11 percent) and S. faecalis in 3 (8,33 percent). In 2003-2004, there were 43 cases, 2 (5 percent) with polymicrobial infection. The most frequent were: Staphylococus coagulase-negative in 16 (35,55 percent), S. aureus in 8 (17,77 percent), E. coli in 7 (15,55 percent) and K. pneumoniae in 3 (6,66 percent). No one was using antibiotic prophilaxys. The prevalence of S. aureus methicillin-resitant to quinolone and trimethoprim-sulfamethoxazole changed from 25 percent to 50 percent, and vancomicin was the only one with absolute activity during all the period. In the same way, the prevalence of E. coli resistant to third generation cephalosporin and to quinolone changed from 0 percent to 16 percent. CONCLUSION: There was a modification of the bacterial population causing spontaneous bacterial peritonitis, with high frequency of gram-positive organisms, as well as an increase in the resistance to the traditionally recommended antibiotics. This study suggests a probable imminent inclusion of a drug...

Bacterial Translocation in Liver Cirrhosis / 대한간학회지

No abstract available.

Klebsiella pneumoniae Septic Arthritis in a Cirrhotic Patient with Hepatocellular Carcinoma

Despite septic arthritis is increasingly being reported in elderly patients with diabetes or alcoholism, reported cases of spontaneous bacterial arthritis in cirrhotic patients are extremely rare. We present the first reported case of K. pneumoniae septic arthritis and spontaneous bacterial peritonitis in a cirrhotic patient with hepatocellular carcinoma. K. pneumoniae, one of the most common causative organisms of spontaneous bacterial peritonitis in cirrhotic patients, was isolated from both the blood and the joint fluid, which suggests that the route of infection was hematogenous. After the treatment with cefotaxime and closed tube drainage, the condition of the patient was improved, and subsequently, the joint fluid became sterile and the blood cultures were proved negative. Therefore, this case provides further evidence for the mode of infection being bacteremia in cirrhotic patients and suggests that the enteric bacteremia in cirrhotics may cause infection in different organ systems.

Producción endógena de alcohol en pacientes con cirrosis hepática, alteración motora y sobrecrecimiento bacteriano / Endogenous ethanol production in patients with liver cirrhosis, motor alteration and bacterial overgrowth

BACKGROUND: Small intestinal bacterial overgrowth generates endogenous ethanol production both in experimental animals and humans. Patients with cirrhosis have small intestinal bacterial overgrowth, but endogenous ethanol production has not been studied in them. AIM: To investigate endogenous ethanol production in patients with cirrhosis, altered intestinal motility and small intestinal bacterial overgrowth. PATIENTS AND METHODS: Eight patients with cirrhosis of different etiologies and altered gastrointestinal motility, consisting in changes in the migrating motor complex, were studied. All had also small intestinal bacterial overgrowth, measured by means of the H2 breath test with lactulose. Plasma ethanol levels were measured by gas liquid chromatography in fasting conditions and 120 min after a carbohydrate rich meal. RESULTS: In fasting conditions, no patient had endogenous ethanol production. Alter the meal, ethanol in concentrations of 11.3 and 8.2 mg/del were detected in two patients. Negligible amounts of ethanol were detected in 4 patients and two patients had undetectable alcohol levels. CONCLUSIONS: A low endogenous production of ethanol was demonstrated in six of eight patients with cirrhosis.

Pulmão e fígado: uma interação ou uma síndrome / Lung and liver: interaction or syndrome?

A cirrose e suas consequências há muito intrigam o médico sobretudo pelo comprometimento multissistêmico e também porque a ciência médica ainda não desvendou boa parte dos aspectos bioquímicos e do metabolismo celular que são afetados pela disfunção hepática crônica. Embora descrita há mais de 100 anos de forma um tanto epírica, a síndrome hepatopulmonar tem sido objeto de estudo e de interesse progressivamente maiores nas últimas décadas. Suas alterações e seus achados começaram, no entanto, a ser bem definidos somente há alguns anos, embora o mecanismo bioquímico etiopatogênico persista na esfera da especulação...

Delta virus infection in cirrhotics in a north Indian hospital.

Forty patients of HBV related cirrhosis of the liver were studied for the presence of delta infection and subsequently the clinical features, course and outcome of these delta infected cases was compared with those of delta uninfected cases. Out of 40 patients studied, only four patients (10%) were reactive for anti-delta antibodies. The incidence of delta infection was common in the younger age group (31.25 +/- 4.78 years) as compared to the older age group (48 +/- 7.25 years) at p < 0.001. Hepatic Encephalopathy was seen in only 13.88% of delta negative patients as compared to 75% of delta infected patients (p < 0.05). During follow up period of 1 year, 75% of patients died in the delta virus infected group as compared to 22.22% in the delta negative group. The mortality was significantly higher in Child's class C (P < 0.01). So delta virus infection is associated with a more severe course of illness and a poorer prognosis in HBV related cirrhotics.

Bacteriological and Immunological studies in children with liver cirrhosis

The patients included in this study were 34 cases presented with liver cirrhosis or bilharzial hepatic fibrosis. They were selected from the Paediatric Gastroentrology Mansoura University Hospital, classified histopathologically into 2 groups cirrhotic group included 19 patients and bilharzial fibrotic group Included 15 patients. In addition, a third group of 10 normal controls of matched age and sex were included. All patients were subjected to thorough clinical exaimination, sigmidoscopy, abdominal ultrasonography, liver biopsy, blood cultures were made and ascitic fluid cultures were done for cases with ascites. The immunolgobulins [lg[A], Ig[G] and Ig[M]] and serum complement levels [C[3c] and C[4]] were determined using single radial immunodiffusion method [Behring - Nor- Partigen Immunodiffusion Plates]. Blood cultures were positive in 48% of cirrhotic and in 7% of bilharzial group [one case only] and negative among Controls. The isolated organisms were E. coli 21%; Staph aureus 11% and mixed gram negative bacilli and Staph. aureus in 16% of cases among the cirrhotic group. In the bilharzial group E. coli was isolated from the positive case. Ascitic fluid cultures were positive in 50% in cases with ascites in the cirrhotic group and negative among the bilharzial group. The isolated organisms were E. coli [36%] and mixed gram negative bacilli and Staph. aureus[14%]. There was a significant rise and difference between the different immunoglobulins level among the studied groups. Evaluation of serum complement levels showed C[3c] and C[4] hypocomplementemia in the two patients groups as compared with control

Prevalence of spontaneous bacterial peritonitis.

To assess the prevalence of spontaneous bacterial peritonitis (SBP), ascitic fluid cell count, and ascitic fluid culture by conventional method and by bedside inoculation in blood culture bottles were performed in 31 consecutive patients of liver cirrhosis. Seven (22.58%) patients had ascitic fluid polymorphonuclear count (PMN) more than 500/mm. Ascitic fluid culture by conventional method was negative in all the patients, while in 4 patients culture was positive by bedside inoculation method. Six of 7 patients with SBP or its variant were in Child class C. Clinical features in these patients were abdominal pain (5 patients), fever (4) and encephalopathy (2); serum bilirubin level was 6.8 +/- 5.5 mg/dl, serum albumin 1.98 +/- 0.2 g/dl, prothrombin index 59.8 +/- 12.2%, ascitic fluid protein 0.78 +/- 0.24 g/dl. Three of 7 patients with SBP or its variant expired during hospital stay; the other 4 patients recovered after appropriate antibiotic therapy. We conclude that SBP is a serious complication in patients of liver cirrhosis with ascites. Ascitic fluid PMN count and bedside inoculation of blood culture bottles with ascitic fluid are sensitive indicators of SBP. Hence they should be performed routinely for early detection of SBP.

Two Cases of Campylobacter fetus Septicemia

Campylobacter fetus subsp. intestinalis was isolated from the blood of two different patients. One patient was a 46-year-old male with liver cirrhosis and the other a 44-year-old male with co1on carcinoma. These are the second and third documented infections of this kind in Korea. Difficulties of their isolation were well illustrated. For instance, the growth was detected after a long incubation of 4 to 6 days. All of the 3 blood cultures from the carcinoma patient, but on1y 2 of 3 specimens from the other patient, yielded the organism.